Managing Managed Care

Our inequitable, inefficient, oftentimes uncaring health care "system," revealed. -- Jeffrey G. Kaplan, M.D., M.S.

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Changing How Medicine's Practiced

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The Bio-Psycho-Social, Collaborative Model of Healthcare "It is possible to screen for and treat depression in the primary care setting. Collaborative care for depression can succeed in diverse settings with a range of staffing combinations, patient demographics, and physical layouts. Centralized data support is essential to drive operational workflows and quality improvement across multiple sites."

Real Reform

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The strategic agenda for real reform lies in creating a value-based health care delivery system. As stipulated by Porter and Lee in 2013, health care will be organized and paid for differently in the near future.  Six critical steps in reform as as follows [modified]: Separate primary from preventive care; reorganize care around patient medical or surgical conditions, forming what they call “Integrated Practice Units” (essentially team work);

Specialist Surfeit; Primary Care Paucity

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It's schadenfreude (enjoyment obtained from the troubles of others).  That's where I find myself as I observe the surfeit of specialists juxtaposed to a dearth of primary care docs. As Dr. Pauline W. Chen said in "Where Have All the Doctors Gone?"—"I [don’t] envy Mr. Obama.... Any attempt to make health care more accessible will be doomed to failure without an adequate number of primary care physicians and a strong primary care system."

Healthcare Reform in the U.S.

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The United States is the only wealthy, industrialized country that does not ensure that all of its citizens have healthcare coverage. Insuring America's Health: Principles and Recommendations, Institute of Medicine at the National Academies of Science, January 14, 2004, last accessed Tuesday, February 2, 2010

"Health Care" and "Insurance Companies"--Oxymoron

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"I don't understand why health care and insurance companies keep appearing in the same sentences." (Fisher, W. Truthout 10/25/09) Isn't it frustrating to have to live under employment based health care insurance?  If you lose your job, your employer wants to cut back, or you are a peasant, you're screwed!  Also, as a result of the way we are paid and the insurance model itself, there are many forces today that steal us away from the exam table or bedside.

Med School Doesn't Teach This

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What new docs need to know and never learned in medical or osteopathic school Harvard Medical School's Top Health Headlines of 2015 as reported in HEALTHbeat, on Twitter, and in their blog. (To read any of these articles or patient education pieces, please go to their website: and/or get a free subscription by registering there.)   Top 5 HEALTHbeat articles How stretching keeps your joints moving Exercise: An effective prescription for joint pain

Heart's Not Healthy? Recouping Tips

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When it comes to health, the better-informed patient does better—Duh! What is a patient to do to reverse or ameliorate heart failure, that is, besides taking meds? ABSTRACT failed to work 5/27/16]pan> Context Little is known about the effects of low health literacy among patients with heart failure, a condition that requires self-management and frequent interactions with the health care system.

Antibiotics, Sensible Use; Injudicious Overuse

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It's easier to prescribe antibiotics in a cold, sinsitis or bronchitis than to explain why not. (It takes less time, it's expected, it's someone else's money and diagnostic confusion from partial or inappropriate treatment will likely be someone else's problem.) Advisory

Reducing Dx Errors

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It's vital to address safety concerns in primary care, especially that which comes from diagnostic errors (i.e., missed, delayed, or incorrect diagnoses). Diagnostic errors are unfortunately all too frequent and they are the largest contributor to "ambulatory malpractice claims (40% in some studies)"; they "cost approximately $300 000 per claim on average."